Figure 3. A 56-year-old male smoker with oligotrophic nonunion of a segmental tibial fracture (case 3).

A) Radiographs of the patient’s left tibia four months after injury, status post tibia and fibula intramedullary nailing at an outside hospital with soleus flap coverage and skin grafting. B) Radiographs of the left tibia demonstrating persistent nonunion (red arrows) with no callous formation at fracture site six months after index surgery. C) Radiographs demonstrating union (green arrows) approximately one year after exchange nailing performed with adjunctive cortical vent drill tunnels. The patient was pain-free at the former tibial nonunion site.